Amniotic fluid: When liquid levels run low

Causes and problems

These are often interrelated. Generally, too little fluid is caused by conditions that prevent - or reduce - the production of amniotic fluid. These include:

• Intrauterine growth restriction (poor growth of the baby) - which can include adhesions of the baby's skin to the inner lining of the sac producing a resulting growth retardation.
• Various developmental abnormalities of the baby - especially kidney or urinary system malformations. There is a higher rate of limb abnormalities and congenital dislocation of the hip and talipes (foot abnormalities), possibly due to an increased pressure.
• Twin-to-twin transfusion syndrome.
• Post-mature (post-term) pregnancy: fluid reduction starts at about 36 weeks, and continues until delivery - a natural oligohydramnios, in other words.
• Premature rupture of the sac (membranes), with slow leaking; and thus a chronic oligohydramnios.

Other complications

Apart from the indications of possible birth defects in a baby, oligohydramnios can cause other, luckily rare, complications:

• As amniotic fluid is very important in the development of various organs in your baby - especially the lungs - too little fluid, especially for long periods of time, may cause these organs to develop abnormally or incompletely.
• Absence of the protective, cushioning function of the amniotic fluid may lead to possible intrauterine damage to your baby.
• In situations where there is a slow leaking of fluid, there is also an increased risk of infection developing within the amniotic sac.
• The biggest danger of a markedly reduced amount of amniotic fluid is complications at delivery; when there will be:
• Increased risk of compression of the baby's umbilical cord, thereby cutting off oxygen and nutrient supplies.
• Possible aspiration - breathing into the lungs - of thick meconium (baby's first bowel movement) during delivery.

Signs, symptoms and diagnosis

Often, women may have no symptoms or signs. The condition may be detected by the examining health professional who may find the uterus 'too full of baby' - being able to feel elbows, knees and hands, which is unusual. Other features of oligohydramnios are:

• Decreased amount or lack of amniotic fluid noted on ultrasound examination; various 'index comparisons' are measured.
• Possible decreased movements of your baby - due to restriction in available space. Sometimes, for the same reason, increased awareness of movement may be noticed by some mothers-to-be.
• Apparent leaking of amniotic fluid, when the cause is a premature rupture of the sac.

Management

• After major abnormalities of the baby have been excluded, a speedy delivery may be helpful if the baby is mature enough to survive. In many other cases, close monitoring and frequent follow-up visits are all that is necessary.
• Amnio-infusion - which is the transfusion of a special fluid into the amniotic sac to replace lost or low levels of amniotic fluid - may be offered or undertaken in some obstetric units. This is still, to some degree, in its experimental stage, but it may certainly help prevent the various lung abnormalities that can occur in the baby. It may also help to prevent compression of the baby's cord at delivery.

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